This is HSJ’s fortnightly briefing covering quality, performance and finances in the mental health sector.

Feedback and comments are welcome, so please feel free to email me in confidence.

A warning shot

The independent panel commissioned by prime minister Theresa May to review the Mental Health Act 1983 published its interim findings this week.

In an interview with me, panel chair Professor Sir Simon Wessely followed its publication by sending a warning shot across the bows of the Treasury – the panel’s recommendations will call for more cash for the sector.

We do not yet know what this figure might be, and probably won’t until the final report and recommendations are published in November or December.

But it places an important marker in the sand over where Sir Simon and his team see the report going.

It also piles the pressure on Ms May and the Department of Health and Social Care. Sir Simon and his team were commissioned to produce the report by the PM herself, when she made her pre-election pledge to rip up and replace the “flawed” act last year.

Sir Simon is very aware of the knife edge the panel is walking – ask for too little and major change is unlikely, but ask for too much and you risk “terrifying the horses so they bolt out of the stable”. This could leave the review gathering dust in the House of Commons library.

That would be a tremendous shame because as the interim findings make clear, the act and the way it is put into practice are long overdue an overhaul.

Out of the shadows

The biggest unknown is what form the promised “sustainable long term plan” for the NHS will take and what offer it will make to the health service in general and mental health in particular.

As HSJ editor Alastair McLellan has already made clear, this settlement should maintain the commitment to a greater proportion of the NHS budget being spent on mental health.

But Sir Simon goes further, saying this is an opportunity to put new energy and investment into supporting people with severe mental illness.

He rightly points out there has been a lot of work to support people with mild to moderate conditions, which makes up much of the focus of the Five Year Forward View for Mental Health.

But, as the panel points out in its report, mental health has long existed in a “twilight zone”. While a light has been shone on many aspects of mental health and mental illness, severe mental health conditions remain in the shadows of public debate.

Back to bread and butter

I have already written that the time is approaching when the work for the next long term plan for mental health needs to get underway.

Sir Simon has thrown his oar in to suggest this must have a focus on improving mental health hospitals and treatment for people with severe mental illnesses.

Sector leaders have also told me that this should focus on “bread and butter” services, inpatient units and community mental health teams.

With the long term funding settlement on the way, there has never been a better time to link these threads.

Not just about money

But, as I have written before, the improvements needed across the sector do not just come down to how much money is being spent.

One major hurdle, which is not part of the independent panel’s remit, is workforce.

While new investment is welcome, until the sector has a workforce strategy that aligns with its financial framework, all the cash in the world is not going to pull new psychiatrists and psychiatric nurses out of thin air.